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Free Accident & Health Producer Practice Questions

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Sample Practice Questions

Try these 10 sample questions from the Accident & Health Producer practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

  1. 1A self-employed designer wants monthly income if an illness prevents her from working. Which policy best addresses her personal lost earnings?

    1. A. Individual disability income policy
    2. B. Business overhead expense policy
    3. C. Key employee disability policy
    4. D. Hospital confinement indemnity policy

    Answer: A

    Explanation: NAIC explains, "Disability insurance is a type of insurance that provides income if a worker is unable to perform their job duties and earn money due to a disability." An individual disability income policy addresses the designer's lost earnings. The other policies address business expenses, a firm's key worker, or a hospital stay.

    Reference: NAIC, Simplifying the Complications of Disability Insurance — Disability Insurance

  2. 2After a health policy is issued, an agent orally promises a broader benefit that is absent from the policy and endorsements. Under Maine's entire-contract provision, what would make a change valid?

    1. A. The agent records the promise in a service note.
    2. B. The agent and insured sign a separate letter.
    3. C. An executive officer approves it and it is endorsed or attached.
    4. D. The insurer cashes the next premium after the promise.

    Answer: C

    Explanation: Maine §2705 states, "No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto." The agent's oral promise does not amend the contract; executive approval and an endorsement or attachment are required.

    Reference: Maine Insurance Code, Title 24-A — Title 24-A §2705, Entire contract -- changes

  3. 3A Medicare beneficiary wants a Medicare-approved private plan that bundles Part A and Part B benefits and usually Part D drug coverage. Which coverage path is this?

    1. A. Original Medicare with separate Part D
    2. B. Medicare Advantage under Part C
    3. C. Medigap with Original Medicare
    4. D. Medicaid with Medicare eligibility

    Answer: B

    Explanation: Medicare.gov says Medicare Advantage plans are private plans and "These “bundled” plans include Part A, Part B, and usually Part D." Part C is the described path. Original Medicare may add separate drug coverage and Medigap; Medicaid is a different program.

    Reference: Medicare.gov, Parts of Medicare — Your Medicare options, Medicare Advantage (also known as Part C)

  4. 4After an injury, a self-employed insured returns to work but earns less because the disability still limits some duties. Which disability-policy feature addresses the resulting income gap?

    1. A. Residual disability benefit rider
    2. B. Waiver of premium benefit rider
    3. C. Future increase option rider
    4. D. Accidental death benefit rider

    Answer: A

    Explanation: NAIC states, "Residual Benefit(s) - This coverage fills the gap in income if you are partially disabled, resulting in reduced income." The insured's return with reduced earnings matches residual disability; the other riders change premiums, future coverage amounts, or death benefits.

    Reference: NAIC, Simplifying the Complications of Disability Insurance — Comparing Disability Policies, Residual Benefit(s)

  5. 5A producer transcribed a client's answers on a disability application and omitted a condition the client disclosed. Before signing the corrected application, whose review of its medical answers is essential to ensure the applicant's disclosures are complete?

    1. A. The producer who transcribed the medical answers
    2. B. The physician who treated the medical condition
    3. C. The client who will sign the application
    4. D. The insurer's medical underwriting reviewer

    Answer: C

    Explanation: Maine’s Bureau tells applicants, "It is important that you disclose all conditions and answer all questions completely." The producer should correct the answer and have the signing client review the complete medical answers. Producer, physician, or underwriter review does not replace the applicant’s own verification.

    Reference: Maine Bureau of Insurance, Shopping for Disability Coverage — Applying for an Individual Disability Income Insurance Policy

  6. 6Under Maine law, which official heads the Bureau of Insurance?

    1. A. Superintendent of Insurance
    2. B. Attorney General
    3. C. State Treasurer
    4. D. Secretary of State

    Answer: A

    Explanation: Section 201 states, "The Superintendent of Insurance is the head of the Bureau of Insurance."

    Reference: Title 24 a Maine Insurance Code — §201(1)

  7. 7When does Maine prohibit different health premiums between applicants?

    1. A. When they are of the same class and essentially the same hazard
    2. B. Whenever their ages differ
    3. C. Whenever plan designs differ
    4. D. Whenever counties differ

    Answer: A

    Explanation: Section 2159 prohibits unfair discrimination between persons "of the same class and of essentially the same hazard."

    Reference: Title 24 a Maine Insurance Code — §2159

  8. 8A sole proprietor is unable to work during recovery, but the firm's rent and employee payroll continue. Which coverage is designed for those operating costs?

    1. A. Individual disability income policy
    2. B. Key employee disability policy
    3. C. Business disability buyout policy
    4. D. Business overhead expense policy

    Answer: D

    Explanation: NAIC says business overhead coverage "covers standard business expenses such as payroll, utilities, rent, etc., while the business owner recovers from a disability." It funds continuing operating expenses; personal income, key employee loss, and ownership buyout address different risks.

    Reference: NAIC, Small Business Insurance — Disability Insurance, business overhead paragraph

  9. 9Four years after issue, a covered sickness begins. The insurer discovers a nonfraudulent application misstatement that was not a named exclusion. Under Maine's time-limit provision, may that misstatement alone void the health policy or defeat this claim?

    1. A. Yes, because any misstatement remains contestable for the policy's life.
    2. B. Yes, if the insurer discovers it before completing claim review.
    3. C. Yes, but only if the applicant has changed occupations since issue.
    4. D. No, the three-year limit bars that nonfraudulent defense for this later loss.

    Answer: D

    Explanation: Maine §2706 provides, "After 3 years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim" for a loss beginning after the period. This nonfraudulent statement cannot alone support the proposed defense for the later sickness.

    Reference: Maine Insurance Code, Title 24-A — Title 24-A §2706, Time limit on certain defenses

  10. 10A 42-year-old adult with limited income meets the applicable eligibility rules for a joint federal-state program that pays for health care. Which program is it?

    1. A. Original Medicare insurance
    2. B. Social Security disability insurance
    3. C. Children's Health Insurance Program
    4. D. Medicaid health coverage

    Answer: D

    Explanation: Medicare.gov states, "Medicaid is a joint federal and state program that provides health coverage for certain low-income people, families and children, pregnant women, the elderly, and people with disabilities." The question states this adult qualifies under applicable eligibility rules; Medicare, SSDI, and CHIP are distinct programs.

    Reference: Medicare.gov, Parts of Medicare — What's the difference between Medicare & Medicaid?

Topics in this practice bank

These topics describe the available practice for Accident & Health Producer. Review the examination outline and its sources for scope and allocation details.

  • Accident & Health – General Knowledge Content Outline / I. TYPES OF POLICIES (16 scoreable questions)
    • A. Disability income
    • A. Disability income > 1. Individual disability income policy
    • A. Disability income > 2. Business overhead expense policy
    • A. Disability income > 3. Business disability buyout policy
    • A. Disability income > 4. Group disability income policy
    • A. Disability income > 5. Key employee policy
    • B. Accidental death and dismemberment
    • C. Medical expense insurance
    • C. Medical expense insurance > 1. Basic hospital, medical, and surgical policies
    • C. Medical expense insurance > 2. Major medical policies
    • C. Medical expense insurance > 3. Health Maintenance Organizations (HMOs)
    • C. Medical expense insurance > 4. Preferred Provider Organizations (PPOs)
    • C. Medical expense insurance > 5. Point of Service (POS) plans
    • C. Medical expense insurance > 6. Flexible Spending Accounts (FSAs)
    • C. Medical expense insurance > 7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • C. Medical expense insurance > 8. Health Reimbursement Accounts (HRAs)
    • D. Medicare supplement policies
    • E. Group insurance
    • E. Group insurance > 1. Differences between individual and group contracts
    • E. Group insurance > 2. General characteristics
    • E. Group insurance > 3. COBRA
    • F. Individual/Group Long Term Care (LTC)
    • F. Individual/Group Long Term Care (LTC) > 1. Eligibility
    • F. Individual/Group Long Term Care (LTC) > 2. Levels of care
    • G. Other policies
    • G. Other policies > 1. Dental
    • G. Other policies > 2. Vision
    • G. Other policies > 3. Cancer
    • G. Other policies > 4. Critical illness or specified disease
    • G. Other policies > 5. Worksite (employer-sponsored)
    • G. Other policies > 6. Hospital indemnity
    • G. Other policies > 7. Short-term medical
    • G. Other policies > 8. Accident
  • Accident & Health – General Knowledge Content Outline / II. POLICY PROVISIONS, CLAUSES, AND RIDERS (15 scoreable questions)
    • A. Mandatory and optional provisions
    • A. Mandatory and optional provisions > 1. Entire contract
    • A. Mandatory and optional provisions > 2. Time limit on certain defenses (incontestable)
    • A. Mandatory and optional provisions > 3. Grace period
    • A. Mandatory and optional provisions > 4. Reinstatement
    • A. Mandatory and optional provisions > 5. Notice of claim
    • A. Mandatory and optional provisions > 6. Claim forms
    • A. Mandatory and optional provisions > 7. Proof of loss
    • A. Mandatory and optional provisions > 8. Time of payment of claims
    • A. Mandatory and optional provisions > 9. Payment of claims
    • A. Mandatory and optional provisions > 10. Physical examination and autopsy
    • A. Mandatory and optional provisions > 11. Legal actions
    • A. Mandatory and optional provisions > 12. Change of beneficiary
    • A. Mandatory and optional provisions > 13. Misstatement of age or gender
    • A. Mandatory and optional provisions > 14. Change of occupation
    • A. Mandatory and optional provisions > 15. Illegal occupation
    • A. Mandatory and optional provisions > 16. Relation of earning to insurance
    • B. Other provisions and clauses
    • B. Other provisions and clauses > 1. Insuring clause
    • B. Other provisions and clauses > 2. Free look
    • B. Other provisions and clauses > 3. Consideration clause
    • B. Other provisions and clauses > 4. Probationary period
    • B. Other provisions and clauses > 5. Elimination period
    • B. Other provisions and clauses > 6. Waiver of premium
    • B. Other provisions and clauses > 7. Exclusions and limitations
    • B. Other provisions and clauses > 8. Preexisting conditions
    • B. Other provisions and clauses > 9. Coinsurance
    • B. Other provisions and clauses > 10. Deductibles
    • B. Other provisions and clauses > 11. Eligible expenses
    • B. Other provisions and clauses > 12. Copayments
    • B. Other provisions and clauses > 13. Pre-authorizations and prior approval requirements
    • B. Other provisions and clauses > 14. Usual, reasonable, and customary (URC) charges
    • B. Other provisions and clauses > 15. Lifetime, annual, or per cause maximum benefit limits
    • C. Riders
    • C. Riders > 1. Impairment/exclusions
    • C. Riders > 2. Guaranteed insurability
    • C. Riders > 3. Future increase options
    • D. Rights of renewability
    • D. Rights of renewability > 1. Noncancelable
    • D. Rights of renewability > 2. Cancelable
    • D. Rights of renewability > 3. Guaranteed renewable
  • Accident & Health – General Knowledge Content Outline / III. SOCIAL INSURANCE (6 scoreable questions)
    • A. Medicare (Parts A, B, C, D)
    • B. Medicaid
    • C. Social Security benefits
  • Accident & Health – General Knowledge Content Outline / IV. OTHER INSURANCE CONCEPTS (5 scoreable questions)
    • A. Total, partial, recurrent and residual disability
    • B. Owner’s rights
    • C. Dependent children benefits
    • D. Primary and contingent beneficiaries
    • E. Modes of premium payments
    • F. Nonduplication and coordination of benefits (e.g., primary vs. excess)
    • G. Occupational vs. non-occupational
    • H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.)
    • I. Managed care
    • J. Workers Compensation
    • K. Subrogation
    • L. Cost containment
  • Accident & Health – General Knowledge Content Outline / V. FIELD UNDERWRITING PROCEDURES (8 scoreable questions)
    • A. Completing the application
    • B. Explaining sources of insurability and HIPAA privacy information (e.g., MIB Report, Fair Credit Reporting Act, etc.)
    • C. Initial premium payment and receipt and consequences of the receipt (e.g., medical examination, etc.)
    • D. Submitting application (and initial premium if collected) to company for underwriting
    • E. Policy delivery
    • F. Explaining policy and its provisions, riders, exclusions, and ratings to clients
    • G. Replacement
    • H. Contract law
    • H. Contract law > 1. Elements of a contract
    • H. Contract law > 2. Insurable interest
    • H. Contract law > 3. Warranties and representations
    • H. Contract law > 4. Unique aspects of the insurance contract
    • H. Contract law > 4. Unique aspects of the insurance contract > a. Conditional
    • H. Contract law > 4. Unique aspects of the insurance contract > b. Unilateral
    • H. Contract law > 4. Unique aspects of the insurance contract > c. Adhesion
    • H. Contract law > 4. Unique aspects of the insurance contract > d. Aleatory
  • Accident & Health – Maine-Specific Content Outline – State Laws and Rules / I. MAINE LAWS AND RULES COMMON TO LIFE, ACCIDENT, AND HEALTH INSURANCE (18 scoreable questions)
    • A. Superintendent of Insurance
    • A. Superintendent of Insurance > 1. Broad powers
    • A. Superintendent of Insurance > 2. Notice and hearing
    • B. Definitions
    • B. Definitions > 1. Authorized, unauthorized, and certificate of authority
    • B. Definitions > 2. Domestic, foreign, and alien
    • B. Definitions > 3. Stock and mutual
    • B. Definitions > 4. Transacting insurance
    • B. Definitions > 5. Maine Life and Health Insurance Guaranty Association
    • C. Licensing requirements and limitations
    • C. Licensing requirements and limitations > 1. Types of licenses
    • C. Licensing requirements and limitations > 1. Types of licenses > a. Producer
    • C. Licensing requirements and limitations > 1. Types of licenses > b. Consultant
    • C. Licensing requirements and limitations > 1. Types of licenses > c. Temporary
    • C. Licensing requirements and limitations > 1. Types of licenses > d. Nonresident
    • C. Licensing requirements and limitations > 1. Types of licenses > e. Limited
    • C. Licensing requirements and limitations > 1. Types of licenses > f. Adjuster
    • C. Licensing requirements and limitations > 1. Types of licenses > g. Business entity
    • C. Licensing requirements and limitations > 1. Types of licenses > h. Apprentice
    • C. Licensing requirements and limitations > 2. Exemptions/exceptions
    • C. Licensing requirements and limitations > 3. Appointment
    • C. Licensing requirements and limitations > 4. License refusal, termination, expiration, revocation, suspension, and nonrenewal
    • C. Licensing requirements and limitations > 5. Educational requirements
    • D. Marketing practices
    • D. Marketing practices > 1. Unfair practices
    • D. Marketing practices > 1. Unfair practices > a. Claims methods and practices
    • D. Marketing practices > 1. Unfair practices > b. Excess charges
    • D. Marketing practices > 1. Unfair practices > c. Rebating
    • D. Marketing practices > 1. Unfair practices > d. Twisting
    • D. Marketing practices > 1. Unfair practices > e. Misrepresentation
    • D. Marketing practices > 1. Unfair practices > f. Defamation
    • D. Marketing practices > 1. Unfair practices > g. False information and advertising
    • D. Marketing practices > 1. Unfair practices > h. Penalties
    • D. Marketing practices > 1. Unfair practices > i. Fraud
    • D. Marketing practices > 1. Unfair practices > j. Cross-selling/Unfair Solicitation Methods
    • D. Marketing practices > 2. Producer responsibilities
    • D. Marketing practices > 3. Compensation of licensees
    • D. Marketing practices > 4. Privacy
    • E. Third-party notice of cancellation
  • Accident & Health – Maine-Specific Content Outline – State Laws and Rules / II. MAINE LAWS AND RULES PERTINENT TO ACCIDENT AND HEALTH INSURANCE ONLY (20 scoreable questions)
    • A. Policy rate discrimination
    • B. Required policy provisions
    • B. Required policy provisions > 1. Coverage for newborns
    • B. Required policy provisions > 2. Coverage for maternity benefits
    • B. Required policy provisions > 3. Coverage for home health care
    • B. Required policy provisions > 4. Coverage for domestic partners
    • B. Required policy provisions > 5. Renewal and cancellation
    • B. Required policy provisions > 6. Assignment
    • B. Required policy provisions > 7. Coverage for dependent children
    • B. Required policy provisions > 8. Emergency services
    • C. Medicare supplement
    • C. Medicare supplement > 1. Benefit standards
    • C. Medicare supplement > 2. Sale of insurance to beneficiaries
    • C. Medicare supplement > 3. Preexisting conditions
    • C. Medicare supplement > 4. Nursing home coverage
    • C. Medicare supplement > 5. Guaranteed issue
    • D. AIDS testing requirements
    • E. Long-Term Care/Partnership coverage
    • F. Continuity of coverage
    • G. Small group and individual health insurance plans
    • G. Small group and individual health insurance plans > 1. Guaranteed issue
    • G. Small group and individual health insurance plans > 2. Guaranteed renewal
    • G. Small group and individual health insurance plans > 3. Coverage and benefits
    • G. Small group and individual health insurance plans > 4. Market practices
    • G. Small group and individual health insurance plans > 5. Rating practices
    • H. Health Maintenance Organization (HMO)
    • I. Medical Utilization Review Entities
    • J. Preferred Provider Arrangement
    • K. Appeals, Grievances, and External Review
    • L. Affordable Care Act
    • L. Affordable Care Act > 1. State based Marketplace/The SHOP Exchange
    • L. Affordable Care Act > 2. Taxes, penalties, and subsidies
    • L. Affordable Care Act > 3. Essential health benefits
    • L. Affordable Care Act > 3. Essential health benefits > a. Mental health parity
    • L. Affordable Care Act > 3. Essential health benefits > b. Pediatric services
    • L. Affordable Care Act > 3. Essential health benefits > c. Preventive services
    • M. Wellness Programs
    • N. COBRA and state continuation coverage
    • O. Pharmacy Benefit Managers

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